Flashcards in Pathology: Uterus Deck (13)
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1
What is primary amenorrhea? Secondary amenorrhea? What are the potential causes?
- primary: absence of menses by age 16
- secondary: loss of menses for at least 6 months in a patient with otherwise normal menstrual history
- causes: pregnancy!, hypothalamic/pituitary disorder, ovarian disorder, anatomical defects
2
What is Asherman syndrome?
- Asherman syndrome is the acquired loss of the stratum basalis (the regenerative layer of the endometrium)
- it is usually due to overly aggressive dilatation and curettage
- this is a rare anatomical defect that can cause secondary amenorrhea (most anatomical defects are present at birth and therefore result in primary amenorrhea)
3
What usually causes endometritis? What finding characterizes chronic cases?
- endometritis is usually due to retained products of conception following delivery/miscarriage/abortion
- chronic cases are characterized by the presence of plasma cells (although chronic infections are related to lymphocytes, lymphocytes are normally already found in the uterus)
4
What are the main causes of abnormal uterine bleeding (AUB) in children? In early reproductive years (menarche to 20)? From 20 to 40? From 40 on?
- prepuberty: vulvovaginitis, embryonal rhabdomyosarcoma of vagina
- menarche to 20: anovulatory cycles due to excess unopposed estrogen, bleeding diathesis, pregnancy
- 20 to 40: pregnancy, PID, leiomyoma (fibroids), endometriosis, endometrial polyp, medication
- 40 on: perimenopause, endometrial hyperplasia and carcinoma
5
What are endometrial polyps? What are they a common cause of?
- these are benign collections of endometrial tissue
- they do NOT progress to carcinoma
- they are a common cause of AUB in females 20-40
6
What causes endometrial hyperplasia? What do we see on histology? How do patients classically present? What are the risk factors and complications?
- endometrial hyperplasia is due to unopposed estrogen, resulting in a constant proliferative phase of the menstrual cycle
- on histo we would see hyperplasia of the glands relative to the stroma
- patients present with AUB, classically with postmenopausal vaginal bleeding (the excessive proliferation results in sporadic cases of shedding)
- RFs: obesity, PCOS, anovulatory cycles, HRT, early menarche, late menopause, nulliparity
- complications: can develop into endometrial carcinoma, so *make sure to take a biopsy to check for the architectural growth (simple or complex) and presence of atypia (typical or atypical)*
7
What is the most common gynecological malignancy? How does it present? What are the two pathways of development? What are the major risk factors?
- endometrial carcinoma is the most common gynecological malignancy (followed by ovarian and then by cervical)
- classically presents in a 55-65 year old female with postmenopausal bleeding
- two distinct pathways: hyperplastic (following endometrial hyperplasia; usually seen in 50s) and sporadic (occurs in an atrophic endometrium with no precursor lesions; usually seen in 70s)
- RFs: (same as endometrial hyperplasia) obesity, PCOS, anovulatory cycles, HRT, early menarche, late menopause, nulliparity
8
Which type of endometrial carcinoma contains psammoma bodies? Which other carcinomas contain psammoma bodies?
- the sporadic form of endometrial carcinoma that develops in an atrophic (postmenopausal) uterus without a precursor lesion (AKA without endometrial hyperplasia)
- contains serous (AKA papillary-serous) histology that can calcify and form psammoma bodies
- PSaMMoma bodies: Papillary thyroid carcinoma, Serous endometrial and Serous ovarian carcinoma, Mesothelioma, Meningioma
9
What is endometriosis? Where does it most commonly occur? What is it the most common cause of? What are some complications?
- endometriosis is the presence of functional endometrial tissue outside the uterus (most common site is the ovary, also the pelvis and peritoneum)
- it is the most common cause of secondary dysmenorrhea (pain on period); it is also the most common gynecological disorder in the reproductive age group
- patients can also present with dyschezia (suggests involvement of the pouch of Douglas), and dyspareunia
- complications: infertility, ectopic pregnancy, carcinoma at the site of involvement (especially with the ovaries)
- (involvement of the ovaries leads to formation of chocolate ovarian cysts)
10
What is adenomyosis? What causes it?
- adenomyosis is essentially endometriosis within the myometrium
- this is caused by hyperplasia of the stratum basalis layer of the endometrium into the myometrium
- in adenomyomis, the uterus is uniformly enlarged (in endometriosis, the uterus is normal)
11
What is a fibroid? Which age does it most commonly affect?
- a fibroid is a leiomyoma (a benign growth of the smooth muscle of the myometrium)
- they are the most common tumor in females!
- peak occurrence at 20-40 (a common cause of AUB in this age group, but are usually asymptomatic)
- *leiomyomas do NOT progress to leiomyosarcomas*
12
What are the major differences between a leiomyoma and a leiomyosarcoma?
- leiomyoma: usually multiple masses, well-defined, white-whorled pattern of smooth muscle bundles, more common in reproductive age group
- leiomyosarcoma: usually a single mass, necrotic and hemorrhaging, more common in postmenopausal age group (leiomyosarcomas arise de novo)
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